Colostomy (sigmoidostomy) creation, double-barreled, laparoscopic

Ideally, the marking and subsequent instruction for stoma care should be performed by specially trained stoma therapists or an experienced surgeon.

Tips:

Trial marking on the lying or already seated patient in the area of the left rectus abdominis muscle (navel height) in a 10 × 10cm skin area, preferably without folds, scars, or bony prominences.
Verification of the intended position in motion (standing, bending).
The chosen site should be easily visible and accessible to the patient and should be compatible with the position of the pants or belt.
Determining an alternative marking is recommended in case of intraoperative complications.
Covering the marking with a skin-friendly adhesive tape.
The position of the stoma significantly influences handling and care, and thus the patient's quality of life!

The skin incision for the creation of the pneumoperitoneum is usually made supraumbilically. The preparation on the fascia is performed partly sharply, partly bluntly with the Langenbeck retractors.

The creation of the capnoperitoneum is performed using a Veress needle following the suction, irrigation, and aspiration test. For this purpose, the fascia should be elevated, for example, with a Mikulicz clamp to avoid perforation of the intestine by the needle. Alternatively, access via a minilaparotomy (e.g., after previous surgeries) is advisable.

After establishing the capnoperitoneum with an intra-abdominal pressure between 11 and 14 mm Hg, the needle is removed, and the 10 mm optical trocar is inserted. Subsequently, the optics are advanced into the abdomen through this.

After a panoramic view and inspection for abnormalities such as adhesions, lesions, etc., the insertion of the two 5 mm working trocars into the right lower and mid-abdomen is performed under direct vision and transillumination (Caution: epigastric vessels).

Grasping the colon segment (here sigmoid) and dislocation medially. If necessary, transect the embryonic adhesions of the sigmoid to the lateral abdominal wall and mobilize the descending colon on the Gerota's fascia. Care must be taken with the ureter.

Note:

When creating an end stoma, after mobilization, the bowel is closed and transected with the Endo-GIA. The afferent limb must then be sufficiently mobilized.